All Patient Refined (APR) DRG in Geriatria: Un nuovo sistema per valutare i costi dell'anziano ospedalizzato

APR-DRG is a patient classification system that is an enhancement of HCFA-DRG because of it takes into account of age and comorbidity risk adjustment. APR-DRG adds four subclasses to each DRG. These four subclasses are expressed as APR-Severity Index (SI) or Mortality Risk Index (MR): mild, moderate, severe, extreme. The overall care consumption of geriatric patients is related not only to the severity of clinical impairment, but also to the functional, cognitive and socio-economic impairment of an individual, as properly assessed by the Comprehensive Geriatric Assessment (CGA). The APR-DRG system was found to be able to identify three groups of patients with a significant different multidimensional impairment, as assessed by the CGA criteria. Dividing the patients according to the APR-SI, a significant different functional, cognitive and comorbidity status were found. APR-DRG is an administrative tool that was found to be able to evaluate the clinical and functional impairment in elderly inpatients. A top down costing method (Yale Costing Model) has been validated in USA and linked to APR-DRG system in order to calculate costs for each severity level. APR-DRG classification system seems to properly evaluate severity, co-morbidity, disability and costs in elderly acute inpatients and may identify frailty as a high risk of great health resource consumption.